Jack Lane IV, PTA
NPI 1275902520ActiveIndividual· Skilled Nursing Facility· Lewiston, ID
Skilled Nursing Facility (PTA) in Lewiston, Idaho, licensed in ID, with an NPI issued in September 2015.
Overview
| NPI | 1275902520 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PTA |
| Sole proprietor | Yes |
| NPI issued | Sep 16, 2015 |
| Last updated in NPPES | Sep 16, 2015 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Skilled Nursing Facility Primary | 314000000X | PTA-3672 | ID |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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